HomeMy WebLinkAboutResolution - 2011-R0313 - Contract - HMS Employer Solutions - Self-Insured Health Care Claims Auditing - 07/27/2011Resolution No. 2011—RO313
July 27, 2011
Item No. 5.3
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to
execute for and on behalf of the City of Lubbock, Contract No. 10144 for Self -Insured
Health Care Claims Auditing Services, by and between the City of Lubbock and HMS
Employer Solutions of Jeffersonville, IN, and related documents. Said Contract is
attached hereto and incorporated in this resolution as if fully set forth herein and shall be
included in the minutes of the City Council.
Passed by the City Council on July 27, 2011
F V9'0*;"Z
TOM MARTIN, MAYOR
ATTEST:
Rebecc -arza, City Secretary
APPROVED AS TO CONTENT:
6hh
Andy B chain, Chief FinanceOfficer
APPROYEP AS TO FORM:
Chad Weaver, Assistant City Attorney
vwxcdocs/RES.Contract-HMS Employer Solutions
June 28, 2011
CONTRACT 10144
Resolution No. 2011-R0313
CONTRACT
This professional services contract is executed this 27th day of July, 2011 by and
between the City of Lubbock, Texas, hereinafter called the City, and HMS Employer
Solutions.
WHEREAS, the City has issued a Request for Proposal (RFP 11 -10144 -DT) for Self -
Insured Health Care Claims Auditing Services; and
WHEREAS, the proposal submitted by HMS Employer Solutions has been selected
as the proposal which best meets the needs of the City to provide such professional
services;
WITNESSETH: IN CONSIDERATION of mutual promises of the parties contained
herein and other good and valuable consideration, the parties agree as follows:
HMS Employer Solutions shall provide the City with the necessary professional
services to audit all funds including those which are covered under the
provisions of the Single Audit Act.
2. The term of the contract shall run from the date of execution and shall complete
the audit within one -hundred and eighty (180) working days. The City and the
contractor may, upon written mutual consent, extend the term by providing
written notice of its intent not less than forty-five (45) days prior to the end of the
term.
The professional audit services shall be provided in accordance with the terms
and conditions set forth in the Request for Proposal, attached hereto as Exhibit C.
An engagement letter will be executed by authorized representatives of both
parties, attached hereto as Exhibit A and HIPPA Business Associate Agreement,
attached hereto as Exhibit B.
4. HMS Employer Solutions shall be compensated for services rendered under this
contract in accordance with the terms and conditions set forth in Exhibit A. The
City shall reimburse travel, lodging or meal expenses according to the IRS
Department of Treasury Publication 1542, Per Diem Rates.
5. No work shall be performed beyond the present scope of this contract without
express prior approval by the governing body of the City.
6. The City or HMS Employer Solutions shall have the right to terminate the
contract upon 30 days written notice.
7. Neither party may assign any of its rights or delegate any of its obligations under
this agreement, without the express written consent of the other. It is agreed that
the failure of any party to invoke any of the available remedies under this
agreement or under law in the event of one or more breaches or defaults by any
QTurchase/BidDocs/11-14144-DT Contract
party under the agreement shall not be construed as a waiver of such provisions
and conditions and shall not prevent the parties from invoking such remedies in
the event of any future breach or default.
8. Each paragraph of this agreement is severable from all other paragraphs. In the
event any court of competent jurisdiction determines that any paragraph or
subparagraph is invalid or unenforceable for any reason, all remaining
paragraphs and subparagraphs shall remain in full force and effect.
9. This agreement shall be interpreted according to and enforced under the laws of
the State of Texas.
10. This agreement contains the entire agreement of both parties hereto, and no
other oral or written agreement shall be binding on the parties hereto. This
agreement supersedes all prior agreements, contracts and understandings of any
kind between the parties relating to the subject matter hereof. This agreement
may be executed in one or more counterparts, each of which shall be deemed an
original, but all of which together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the parties hereto have executed this professional
services contract on or as of the date first written above.
CITY OF LUBBOCK HEALTH MANAGEMENT SYSTEMS,
INC. dba HMS Employer jSolutions
By:
Tom Martin, Mayor Donna PriceSe r Vice President
ATTEST:
-Q AaAAC-1-
Rebe a Garza, City Secreta
APPROVED AS TO CONTENT:
aj4a� kq Jvt�- An�
Leisa Hutcheson, Director of Human Resources
And Risk Management
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Assistant City Attorney
Q:PurchaselBidDocsr11-10144-DT Contract
Resolution No. 2011-R0313
EXHIBIT A
CLAIMS AUDIT LETTER OF ENGAGEMENT
1. Scone of Examination. HMS will perform an Examination of the documents,
books, files, and/or other records pertaining to the Claims Administrators, identify any
overpayments, and investigate whether the Claims Administrators have properly
accounted for pricing discounts in the pricing of claims charged to Client and Plan
beneficiaries for claims paid starting on an agreed upon date determined during the
Planning Phase and continuing through the most currently available data as of the time
the Examination begins. The Examination will be conducted in accordance with the
proposal.
2. Client Obligations. Client will pursue its rights to examine the paid claims and
supporting documentation and shall cooperate with all reasonable requests by HMS
during the Examination. HMS shall not be held financially responsible for provision of
Examination service if Client is prevented from conducting the Examination by the
Claims Administrators. Client shall make available to HMS all non -privileged books and
records required by HMS to perform the Examination as described hereunder including,
but not limited to, all documents subsequent to the effective date of the Agreement and
related to savings or recovery from or settlements with Claims Administrators, credits,
reimbursements, offsets, deductions, debt forgiveness, reductions in administrative fees
and charges in favor of Client, and/or claims against, or damages or judgments from
Claims Administrators.
3. Audit Methodologies and Process Overview. Client will submit medical claims
paid from the agreed upon date determined during the Planning Phase. Client and HMS
will mutually agree on the methods or means by which HMS conducts the Examination.
In the event that Client and HMS enter into an agreement with any Claims Administrators
arising from the Examination, such agreement with Claims Administrators will be
proposed in a format recommended by HMS and mutually agreed-upon by the Parties.
HMS shall issue to Client a report of its findings from the Examination ("Audit Report').
As soon as possible, but not later than upon the issuance of the Audit Report, Client and
HMS shall promptly and diligently pursue recovery from Claims Administrators of all
amounts to which HMS reasonably determines Client is entitled. HMS shall not, without
the prior written consent of Client: (a) take any action adverse to the interests of any of
Client's current or former employees or plan beneficiaries including, but not limited to,
the pursuit of any recovery from Claims Administrators or the institution of any legal
proceeding or claim against Claims Administrators; or, (b) hire or retain legal counsel,
accountants, or other consultants or experts in pursuit of recovery from Claims
Administrators. Client shall have the sole discretion and authority, after consultation
with HMS, to settle or litigate claims against Claims Administrators. Neither Client nor
HMS shall conclude any settlement or compromise any claim with Claims
Administrators without prior written notice to and consultation with the other. HMS will
regularly apprise Client of the status of the Examination, provide Client with all
information relating to the Examination which Client reasonably requests, consult with
Q Purchase/BidDocs/11-10144-DT Contract
Client before beginning, include Client in any negotiations with Claims Administrators
for recovery of any amounts to which HMS determines Client is entitled, and terminate
the Examination at the direction of Client, pursuant to Section 8. HMS does not.
guarantee or warrant that any recovery will be received from or settlement reached with
Claims Administrators.
4. Examiner Exclusive . Until the Agreement is terminated pursuant to Section
8, HMS shall have the exclusive right and authority to conduct audits and to pursue
recoveries and savings from Claims Administrators on behalf of client as described
above, by such methods and in such manner as HMS deems appropriate.
5. Confidential Information. "Confidential Information" includes: a) certain
Examination information, including information linking a diagnosis to a specific
beneficiary of the Plan and other individually identifiable information, which is subject to
legal privacy requirements (specifically, HIPAA requirements), a violation of which may
harm Client, Claims Administrators, and/or Plan beneficiaries; b) the methodologies and
procedures utilized by HMS in conducting the Examination; and c) such specific
proprietary financial or business information as Client or HMS designates as
"Confidential." The Parties shall comply with all legal privacy requirements referred to
herein and shall not disclose, directly or indirectly, to any third party, any Confidential
Information described in this Section. These provisions relating to Confidential
Information described in this Section shall survive, and remain in effect for six (6) years
after, the termination of the Agreement. The parties acknowledgment that this agreement
is subject to the Texas Public Information Act and that any request for information
received by the City of Lubbock shall be responsible to conforming with the Texas Public
Information Act
6. Fees. Client shall pay HMS on the following terms, for services rendered to
Client:
❑ $55,800 to be paid in equal installments for the following milestones:
o 30% due upon contract signing
o 70% due upon the delivery of the Draft Audit Report.
❑ The proposed pricing above will be honored for a term of 60 days
from 6/28/11 and expires thereafter if not executed.
❑ Travel expenses as incurred are in addition to the above fees.
QTurchase/BidDocO 1 -10144 -DT Contract
7. Independent Contractor and Compliance. HMS shall perform its services
hereunder as an independent contractor and not as an agent or employee of Client. As
such, the conduct and control of the Examination conducted by HMS shall lie solely with
HMS. HMS shall comply with all applicable laws and governmental rules and
regulations. HMS shall have no authority, without the prior written consent of the Client,
to use the logos or trademarks of Client or its parent, affiliates or subsidiaries for any
purpose other than fulfilling its responsibilities under the Agreement.
8. Indemnification. HMS shall indemnify, defend and hold harmless Client and
its directors, officers and employees from and against any and all claims, liabilities,
losses or damages, including reasonable attorney's fees, which arise from HMS's
intentional or negligent acts during its performance under this Agreement. To the extent
allowed by law, clients shall indemnify, defend and hold harmless HMS and its directors,
officers and employees from and against any and all claims, liabilities, losses or damages,
including reasonable attorney's fees which arise from Client's intentional or negligent
acts during its performance under this Agreement.
9. Notices. All notices required hereunder shall be in writing and deemed given
when mailed, certified U. S. Mail, postage prepaid, to the address below:
If to Client: L 1 o 1L
13 ►.' Le' 54 Hufdv!5c-,7
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Lqu s7
If to HMS: HMS Employer Solutions
355 Quartermaster Court
Jeffersonville, IN 47130
ATTN: Donna Price, Senior Vice President
10. Nonfiduciary. The Parties understand and agree that the Agreement does not
grant HMS any authority or control, discretionary or otherwise, respecting management
of any employee benefit plan of Client nor any authority or control respecting the
management or disposition of any plan assets, that HMS is not rendering investment
advice for a fee or other compensation, direct or indirect, with respect to any moneys or
other property of any plan, nor does HMS have any authority or responsibility to do so,
and HMS has no discretionary or other authority or discretionary or other responsibility
in the administration of any Plan. HMS is not a fiduciary of the Plan and owes no
fiduciary duties to Plan Participants.
QTurchaserBidDacsll 1 -10144 -DT Contract.
11. Modification and Intenwetation. This Agreement constitutes the entire
understanding of the parties concerning the subject matter and no changes, amendments
or alterations hereto shall be effective unless in writing and signed by the Parties. The
adjudged invalidity of any term shall not affect the validity of any remaining terms. The
Agreement is clear and there are no ambiguities in any material respect. The Agreement
may be executed in counterparts and electronic or facsimile representations are valid if
original. The laws of the State of Indiana shall govern the validity, interpretation and
enforcement of the Agreement. The Parties are fully aware of the contents and effects of
the Agreement, and its execution and delivery are not the result of any coercion, fraud,
duress, mistake or undue influence.
12. Publicity. HMS may include Client's name in its client list, and either party
may issue press releases regarding the existence, or general non -confidential business
terms of this Agreement, subject to prior written approval of the other party, which
approval shall not be unreasonably withheld.
IN WITNESS WHEREOF, the Parties have entered into the Agreement effective
as of the date written above.
HEALTH MANAGEMENT SYSTEMS,
INC. DBA HMS EMPLOYER
SOLUTIONS
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D a Price
Title: Senior Vice President
Date: t 9N
Q Purchase/BidDocs/l1-10144-DT Contract
CITY OF LUBBOCK, TEXAS
A tc_:1 e n
Title. <<e`k-o•c o� V mam I6sm eces
Date: q 2,0 ` (
Resolution No. 2011-RO313
Exhibit B
HIPAA Business Associate Aureement
This HIPAA BUSINESS ASSOCIATE AGREEMENT (the "Agreement") is
made effective the July 14, 2011, by and between City of Lubbock, Texas, as Plan
Sponsor ("Client"), by and on behalf of the City of Lubbock, Texas Health Insurance
Plan, ("Covered Entity"), and Health Management Systems, Inc, dba HMS Employer
Solutions, ("Company"), (each individually, a "Party" and Client and Company together,
the "Parties").
WHEREAS, Client and Company have entered into an agreement ("Service
Agreement") through which Company will provide dependent eligibility review services
on behalf of Covered Entity ("Services"); and
WHEREAS, in connection with provision of the Services, Company may have
access to Protected Health Information, or PHI, as defined below, that is subject to
restrictions and obligations under the Health Insurance Portability and Accountability Act
of 1996, as amended ("HIPAA") and the American Reinvestment and Recovery Act of
2009 ("ARRA"); and
WHEREAS, the Parties now desire through this Agreement to amend those
provisions of the Service Agreement pursuant to which Company may have access to
Protected Health Information, to comply with HIPAA and ARRA, and regulations issued
thereunder as set forth in Title 45, Parts 160, 162 and 164 of the Code of Federal
Regulations ("HIPAA Regulations").
THEREFORE, in consideration of the Parties' continuing obligations under the
Service Agreement, and other good and valuable consideration, the Parties agree as
follows:
1. Definitions. The following definitions shall serve to define the terms used within
this Agreement. Capitalized terms used, but not otherwise defined in this Agreement or
the Service Agreement, shall have the meanings given to them in the HIPAA
Regulations.
(a) "Breach" shall mean the acquisition, access, use or disclosure of PHI in a
manner not permitted under the HIPAA Privacy Regulations which compromises the
security or privacy of the PHI.
(b) "Business Associate" shall have the meaning of the term "business associate"
as defined at 45 CFR 160.103, and for purposes of this Agreement, shall refer to
Company.
(c) "Covered Entity" shall have the meaning of the term "covered entity" as
defined in 45 CFR 160. For purposes of this Agreement, Covered Entity shall refer
specifically to Covered Entity as defined above.
Q:Purchase/BidDms/ 11- 10144 -DT Contract
(d) "Designated Record Set" means a "designated record set" as such term is
defined in 45 CFR Section 164.501 containing PHI that is created, acquired, received,
used, maintained or accessed by Company, its employees, agents or representatives.
(e) "Discovered" shall mean the first day upon which a Breach is known to the
Company, or, by exercising reasonable diligence should have been known to the
Company.
(f) "Electronic PHI" means "electronic protected health information" as such
term is defined in 45 CFR Section 160.103.
(g) "HIPAA" means the Health insurance Portability and Accountability Act of
1996, as amended and as such may be further amended from time to time, including all
interim final rules, final rules and regulations promulgated thereunder.
(h) "HIPAA Breach Notification Regulations" means the federal regulations
under ARRA requiring, among other things, the provision of notification of breach of
Unsecured Protected Health Information and as incorporated into the Privacy Rule at 45
CFR Parts 160 and 164, as amended, and as such may be further amended from time to
time.
(i) "Individual" means "individual" as such term is defined in 45 CFR Section
164.501 and shall include a person who qualifies as a Personal Representative in
accordance with 45 CFR 164.502(g).
0) "Privacy Rule" means the federal privacy regulations under HIPAA as
contained in 45 CFR Parts 160 and Part 164, as amended, and as such may be further
amended from time to time.
(k) "Protected Health Information" or "PHI" means "protected health
information" as such term is defined in 45 CFR Section 164.501. For purposes of this
Agreement, PHI shall be limited to PHI created, acquired, accessed, maintained, used or
disclosed by Company, its employees, agents or representatives from or on behalf of the
Covered Entity.
(1) "Required by Law" means "required by law'' as such term is defined in 45
CFR Section 164.501.
(m)"Secretary" means the Secretary of the U.S. Department of Health and Human
Services or her designee.
(n) "Security Incident" means "security incident" as such term is defined in 45
CFR Section 164.304.
Q: urchase/BldDoes/11-14144-DT Contract
(o) "Security Rule" means the federal security standards under HIPAA as
contained in 45 CFR Parts 160, 162 and 164, as amended, and as such may be further
amended from time to time.
(p) "Transaction Rule" shall mean the federal standards for electronic transactions
under HIPAA as contained in 45 CFR Parts 160 and 162, as amended, and as such may
be further amended from time to time.
(q) "Unsecured PHI" means "unsecured protected health information" as such
term is defined in 45 CFR Section 164.402. For purposes of this Agreement, Unsecured
PHI shall be limited to Unsecured PHI created, acquired, accessed, maintained, used or
disclosed by Company, its employees, agents or representatives, from or on behalf of
Covered Entity.
2. Obligations of Business Associate. Company agrees to abide by the terms of this
Agreement and comply with the applicable provisions of the Privacy Rule with respect to
any PHI that Company creates, acquires, receives, uses, maintains, accesses, or discloses
in connection with the Service Agreement.
(a) Company agrees that it will use or disclose PHI solely for meeting its
obligations as set forth in the Services Agreement and this Agreement or as otherwise
approved by the Covered Entity.
(b) Company will ensure that its agents, including any subcontractors, to whom
Company may provide PHI agree to the same restrictions and conditions that apply to
Company with respect to such information. In addition, Company agrees to take
reasonable steps to ensure that its agents' actions or omissions do not cause it to breach
the provisions of this Agreement.
(c) Company shall provide sufficient HIPAA training to its employees, agents
and representatives to whom it provides access to PHI in order for such employees,
agents and representatives to fully understand and comply with Company's HIPAA
obligations under this Agreement.
(d) Company agrees to implement appropriate safeguards to prevent any use or
disclosure of PHI by Company or its agents other than as permitted in this Agreement.
(e) Company will report to Covered Entity any use or disclosure of PHI that is not
permitted under the terms of this Agreement of which Company becomes aware.
(f) Company agrees to mitigate, to the extent practicable, any harmful effect that
is known to Company of a use or disclosure of PHI by Company, its employees, agents or
representatives in violation of the requirements of this Agreement.
(g) Company agrees to make available PHI in accordance with Covered Entity's
policy and the requirements of Section 164.524 of the Privacy Rule. Effective Feb. 17,
Q:PurchasefSidDocs'l 1 -10144 -DT Contract
2010, such right to copy and inspect shall include a right to an electronic copy of PHI that
is maintained or stored in an electronic format and a right of Plan participant to direct that
such record be provided to an entity or person designated by Plan participant, consistent
with ARRA.
(h) Company agrees to make PHI available for amendment and incorporate any
amendments to PHI in accordance with Covered Entity policy and the requirements of
Section 164.526 of the Privacy Rule.
(i) Company agrees to make PHI available for purposes of accounting for
disclosures in accordance with Covered Entity policy and the requirements of Section
164.528 of the Privacy Rule.
0) Upon termination of this Agreement for any reason, Company agrees either to
return to Covered Entity or to destroy all PHI that is in the possession or control of
Business Associate or its agents in any form and retain no copies of such PHI; or if return
or destruction is not feasible, extend the terms and conditions of this Agreement to such
information and limit further uses and disclosures to those purposes that make return or
destruction of the information infeasible for as long as such PHI is retained.
(k) The Secretary of Health and Human Services shall have the right to audit
Company's records and practices related to use and disclosure of PHI to ensure Covered
Entity's compliance with the terms of the HIPAA Regulations.
3. Security Rule Compliance.
(a) Safeguards. Company shall implement administrative, physical and technical
safeguards that reasonably and appropriately protect the confidentiality, integrity and
availability of the Electronic PHI that it accesses, creates, receives, maintains, uses or
transmits on behalf of the Covered Entity as required by, and as more specifically set
forth in, the final Security Rule. Effective Feb. 17, 2010, Company shall have
implemented and shall maintain for the term of this Agreement safeguards including
written policies and procedures under 45 CFR 164.316 that fully comply with the
administrative standards of 45 CFR 164.308, the physical standards of 45 CFR 164.310,
and the technical safeguards of 45 CFR 164.312
(b) Security Incidents. Company agrees to report in writing to the Covered Entity
any Security Incident by Company or any of its agents or representatives relating to
Electronic PHI.
4. Transaction Rule.
To the extent the Services involve Company conducting, or assisting the Covered
Entity in conducting, electronic transactions governed by the Transaction Rule, Company
agrees it will not: (a) Change the definition, data, condition, or use of a data element or
segment in a standard as required by 45 CFR § 162.915; (b) Add any data elements or
to
Q:Purchas6BidDocsl1 1 -I0144 -DT Contract
segments to the maximum defined data set as required by 45 CFR § 162.915; (c) Use any
code or data elements that are either marked "not used" in the standard's implementation
specification or are not in the standard's implementation specification(s) as required by
45 CFR § 162.915; and (d) Change the meaning or intent of the standard's
implementation specification(s) as required by 45 CFR § 162.915.
5. Breach Notification for Unsecured PHI.
(a) Obligation to Exercise Reasonable Diligence. Company shall exercise
reasonable diligence to detect any Breach of Unsecured PHI, and provide training and
procedures through which its employees, agents and representatives are encouraged to
detect and report to Company any Breach of Unsecured PHI.
(b) Upon any "breach" of "unsecured PHI" in Company's control or possession
affecting a Plan participant, Company shall notify Covered Entity as soon as possible
after discovery of a breach; provide any ARRA-required notice to an affected Plan
participant (with any such communications subject to the approval of the Covered Entity,
which approval shall not be unreasonably withheld); provide any ARRA-required notice
to a government agency; and provide any ARRA-required notice to a media outlet (with
any such notice and the release of it subject to the approval of the Covered Entity, which
approval shall not unreasonably be withheld). Further, with respect to any breach of PHI
in Company's control or possession, Company shall promptly notify Covered Entity of
any such breach; explain to
Covered Entity any relevant state law notice or other obligations with respect to such
breach; comply with all state notice or other laws applicable to such breach; and
reimburse the Client or Covered Entity for any reasonable expenses incurred in meeting
their state law obligations in responding to the breach.
6. Termination for Cause.
6.1 Termination for Cause. If the Covered Entity becomes aware or is
notified of a material breach of this Agreement or a Breach of Unsecured PHI by
Company, its employees, agents or representatives, the Covered Entity may:
(a) Provide Company with an opportunity to cure the breach or end the
violation within ten (10) days of receiving notice of the breach and/or violation, and, if
such action does not successfully bring about cure of the breach or an end to the violation
within the time specified by Covered Entity; shall terminate this BAA and the underlying
contract or relationship under which the Company or Business Associate has access to,
uses or disclosed PHI on behalf of Covered Entity; or
(b) Immediately terminate this BAA and the underlying contract or
relationship under which the Company or Business Associate has access to, uses or
disclosed PHI on behalf of Covered Entity; if cure of the breach or causing the violation
to end is not possible; or
(c) If neither termination nor cure is feasible, Covered Entity shall report the
violation to the Secretary.
QTurchaw/SidDocO 1 -10144 -DT Contract
Effective Feb. 17, 2010, the provisions of this Sec. 6.1 shall apply to both parties
in the event that either becomes aware of a breach of this Agreement by the other.
7. Notice to Covered Entity. Any notice required under this BAA to be given to
Covered Entity shall be made in writing to:
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8. Notice to Company or Business Associate. Any notice required under this BAA
to be given to Company or Business Associate shall be made in writing to:
Alexandra Holt
Chief Privacy and Compliance Officer
401 Park Avenue South
New York, NY 10016
(212) 857-5337
aholtnhms.corn
9. Amendment. At the request of the Covered Entity, Company agrees to take such
action as is necessary to amend this Agreement from time to time as is necessary for the
Covered Entity to comply with its HIPAA obligations. If the Covered Entity and
Company do not agree upon such amendments in a timely manner in order to ensure that
the Covered Entity continues to comply with its HIPAA obligations, the Covered Entity
may terminate the Service Agreement and this Agreement immediately by providing
Company with prior written notice.
10. Interpretation. Any ambiguity in this Agreement shall be resolved to permit the
Covered Entity to comply with HIPAA. If there is any conflict between the terms of this
Agreement and the terms of the Service Agreement, the terms of this Agreement shall
control.
11. Rights in Third Parties. This Agreement shall not create any rights in any third
parties.
12. Survival. The obligations under this Agreement survive the expiration,
termination, or cancellation of this Agreement and/or the Service Agreement, and shall
continue to bind Company and its agents, employees, contractors, successors, and assigns
as set forth herein.
13. Inconsistencies with the HIPAA Regulations. In the event of an inconsistency
between the provisions of this Agreement and mandatory provisions of the HIPAA
Regulations, as amended, or their interpretation by any court or regulatory agency with
authority over Covered Entity or Company hereto, the HIPAA Regulations, as interpreted
12
Q: Purchase/Bi&Docs(1 I -10144 -DT Contract
by such court or agency, shall control. Where provisions of this Agreement are different
than those mandated in the HIPAA Regulations, but are nonetheless permitted by such
rules as interpreted by relevant courts or agencies, the provisions of this Agreement shall
control.
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the
day and year written above.
633-ViNIV "I
CLIENT:
HEALTH MANAGEMENT SYSTEMS, CITY OF LUBBOCK, TEXAS
INC. DBA HMS EMPLOYER
SOLUTIONS
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M116
RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
Resolution No. 2011-RO313
Cut along the outer border and affix this label to your sealed proposal envelope to identify
it as a "Sealed Proposal" be sure to include the name of the company submitting the
proposal.
,----------------------------------------------------------------
SEALED PROPOSAL • DO NOT OPEN
RFP NO: 11 -10144 -DT
SELF-INSURED HEALTHCARE CLAIM
AUDITING SERVICES
e ,
DUE DATE/TIME:
May 26, 2011, 3:00
SUBMITTED BY:
CONTACT PHONE NUMBER:
---------------------------
Proposal must be addressed to:
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 13th Street, Room 204
Lubbock, Texas 79401
Q:Purchase/Bid Docsl I 1- 10 144 -DT
RFP 11-10144-D7", Self -Insured Health Care Auditing Services
Self -Insured Health Care Auditing Services
CITY OF LUBBOCK, TEXAS
RFP 11 -10144 -DT
Checklist
Please ensure that you complete and return the following documents and information to the City of Lubbock Purchasing and
Contract Management Department before the deadline. Any corrections must be initialed by person making the correction. Late
submittals will not be accepted.
FAILURE TO PROVIDE ANY OF THE ABOVE MAY RESULT IN YOUR PROPOSAL BEING DEEMED NON-
RESPONSIVE.
Invitation to Proposal Form MUST be completed
Print Name of Company.
1
Contact Person/Phone
PLEASE INCLUDE THIS COMPLETED PAGE AS THE FIRST PAGE OF YOUR SUBMITTAL.
Q:PurchaseBid Docs/11-10144-DT 2
The Request for Proposal Form MUST be completed in blue or black ink or by typewriter.
Signatures must be original, in blue or black ink, and by hand. Include firm's FEDERAL TAX ID
number or SOCIAL SECURITY number. (Page 4).
Clearly mark the RFP number, title, due date and time, and your company name and address on
the outside of the sealed envelope or container.
Completed and signed SUSPENSION AND DEBARMENT CERTIFICATION. Please include
Company Federal TAX Id number or Social Security number. (Page 21)
Insurance Requirement Affidavit (Page 22)
Consideration of Location of Bidder's Principal Place of Business Affidavit of Eligibility form (if
applicable). (Page 23)
Please return original and three copies of the sealed proposal.
FAILURE TO PROVIDE ANY OF THE ABOVE MAY RESULT IN YOUR PROPOSAL BEING DEEMED NON-
RESPONSIVE.
Invitation to Proposal Form MUST be completed
Print Name of Company.
1
Contact Person/Phone
PLEASE INCLUDE THIS COMPLETED PAGE AS THE FIRST PAGE OF YOUR SUBMITTAL.
Q:PurchaseBid Docs/11-10144-DT 2
RFP 11 -10144 -DT, Self -Insured Health Cue Auditing Services
Self -Insured Health Care Auditing Services
CITY OF LUBBOCK, TEXAS
RFP 11 -10144 -DT
In an effort to better serve the business community, the City of Lubbock Purchasing and Contract Management Department is
conducting the following survey. We appreciate the time and effort expended to submit your offer. Please take an additional
moment to complete the information below. If you have any questions or need more information, please call (806)775-2572,
HOW DID YOU RECEIVE NOTICE OF THIS REQ VEST FOR PROPOSALS?
Lubbock Avalanche Journal?
Yes No
City of Lubbock Channel 2
Yes No
From Plan Room or other type of service?
Yes No
Did you access the City of Lubbock website to search for Proposals?
Yes No
Facsimile or email from bidsync.com?
Yes No
Did you download from your home computer?
Yes No
Did you download from your company computer?
Yes No
Requested a copy from Lubbock Purchasing and Contract Management Department?
Yes No
Are you a member of Bid Sync?
Yes No
Other:
Please include this page with your submittal.
THANK YOU.
Q:Purchase/Bid 11 -Docs/ 1 -10144 -DT 3
RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
SUBMIT TO:
CITY OF LUBBOCK
'
ity of
fl'ubbo&
CITY OF LUBBOCK., TEXAS
Purchasing & Contract Management
1625 Rm 204
ruts REQUEST FOR
`•C
Lubbock,Street,
ck, Tx 79401-3830
AN EQUAL
PROPOSAL
CONTACT PERSON:
D'Ana Torres
OPPORTUNITY
YER
11 -10144 -DT
TEL: 806.775.2167
FAX: 806.775.2 l 64
http://purchasing.ei.lubbock.tx.us
TITLE: Self -Insured Health Cale Auditing Services
SUBMITTAL DEADLINE:
May 26, 2011 at 3:00 P.M. CST
PRE PROPOSAL MEETING DATE, TIME AND LOCATION: May 17, 201 1
.Any proposals received alter the time and date listed above, regardless
at 10:00 at Ci Hall, Room 204, Lubbock, TX 79401
of the mode ojdelivery. shall be returned unopened.
RESPONDENT NAME:
IF RETURNING AS A "NO RESPONSE", PLEASE STATE REASON.
MAILING ADDRESS:
CITY — STATE — ZIP:
THE CITY OF LUBBOCK RESERVES THE RIGHT TO ACCEPT OR REJECT ANY AND
ALL PROPOSALS IN WHOLE OR IN PART AND WAIVE ANY INFORMALITY
IN THE COMPETITIVE PROPOSAL PROCESS. FURTHER, THE CITY
TELEPHONE NO:
RESERVES THE RIGHT TO ENTER INTO ANY CONTRACT DEEMED TO BE
IN THE BEST INTEREST OF THE CITY.
IT IS THE INTENT AND PURPOSE OF THE CITY OF LUBBOCK THAT THIS
FAX NO:
REQUEST PERMITS COMPETITIVE PROPOSALS. IT IS THE OFFEROWS
RESPONSIBILITY TO ADVISE THE CITY OF LUBBOCK DIRECTOR OF
E-MAIL:
PURCHASING AND CONTRACT MANAGEMENT IF ANY LANGUAGE,
REQUIREMENTS, ETC., OR ANY COMBINATIONS THEREOF,
FEDERAL TAX ID NO. OR SOCIAL SECURITY NO.
INADVERTENTLY RESTRICTS OR LIMITS THE REQUIREMENTS STATED
IN THIS RFP TO A SINGLE SOURCE, SUCH NOTIFICATION MUST BE
SUBMITTED IN WRITING AND MUST BE RECEIVED BY THE DIRECTOR
OF PURCHASING AND CONTRACT MANAGEMENT NO LATER THAN FIVE
S BUSINESS DAYS PRIOR TO THE ABOVE SUBMITTAL DEADLINE.
THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON ANY ADDENDA POSTED ON
BIDSYNC.COM
The City of Lubbock Charter states that no officer or employee of the City can benefit from any contract, job, work or service for the municipality or be
interested in the sale to the City of any supplies, equipment, material or articles purchased. Will any officer or employee of the City, or member of their
immediate family, benefit from the award of this proposal to the above firm? YESe NO
IN COMPLIANCE WITH THIS SOLICITATION, THE UNDERSIGNED OFFEROR HAVING EXAMINED THE REQUEST FOR PROPOSAL, AND
BEING FAMILIAR WITH THE CONDITIONS TO BE MET, HEREBY SUBMITS THE FOLLOWING. AN INDIVIDUAL AUTHORIZED TO BIND THE
COMPANY MUST SIGN THE FOLLOWING SECTION. FAILURE TO EXECUTE THIS PORTION MAY RESULT IN PROPOSAL REJECTION.
By my signature I certify that this offer is made without prior understanding, agreement, or connection with any corporation, firm, business entity, or person
submitting an offer for the same materials, supplies, equipment, or service(s), and is in all respects fair and without collusion or fraud. I further agree that if the
offer is accepted, the offeror will convey, sell, assign, or transfer to the City of Lubbock all right, title, and interest in and to ail causes of action it may now or
hereafter acquire under the Anti-trust laws of the United States and the State of Texas for price fixing relating to the particular commodity(s) or service (s)
purchased or acquired by the City of Lubbock. At the City's discretion, such assignment shall be made and become effective at the time the City tenders final
payment to the vendor.
Authorized Signature
Title
Print/Type Name Date
THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR RESPONSE.
Q:Purchase/Bid Docs/11-10144-DT
RFP l I -10144 -DT, Sclf-Ensured Health Care Auditing Services
Self -Insured Health. Care Auditing Services
CITY OF LUBBOCK, TEXAS
RFP 11 -10144 -DT
The City of Lubbock appreciates your time and effort in preparing your proposal. All offerors should
familiarize themselves with the following INSTRUCTIONS TO OFFERORS and GENERAL
REQUIREMENTS:
I. INSTRUCTIONS TO OFFERORS
PROPOSAL DELIVERY, TIME & DATE
1.1 The City of Lubbock will receive written and sealed competitive proposals for Self -Insured
Health Care Auditing Services until 3:00 p.m. CST, May 26, 2011, if date/time stamped
on or before 3:00 p.m, at the office listed below. Any proposal received after the date and
hour specified will be rejected and returned unopened to the offeror. Each proposal and
supporting documentation must be in a sealed envelope or container plainly labeled in the
lower left-hand corner: "RFP 11 -10144 -DT, Self -Insured Health Care Auditing
Services" and the closing date and time. Offerors must also include their company name
and address on the outside of the envelope or container. Proposals must be addressed to:
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 13th Street, Room 204
Lubbock, Texas 79401
1.2 Offerors are responsible for making certain proposals and proposed contracts are delivered
to the Purchasing and Contract Management Department. Mailing of a proposal does not
ensure that the proposal will be delivered on time or delivered at all. If offeror does not
hand deliver proposal, we suggest that he/she use some sort of delivery service that
provides a receipt. The City of Lubbock assumes no responsibility for errant delivery of
proposals, including those relegated to a courier agent who fails to deliver in accordance
with the time and receiving point specified.
1.3 Proposals will be accepted in person, by United States Mail, by United Parcel Service, or by
private courier service. No proposals will be accepted by oral communication, telephone,
electronic mail, telegraphic transmission, or telefacsimile transmission. THE CITY WILL
NOT ACCEPT FAX PROPOSALS.
1.4 Proposals may be withdrawn prior to the above scheduled time set for closing. Alteration
made before RFP closing must be initialed by offeror guaranteeing authenticity.
1.5 The City of Lubbock reserves the right to postpone the date and time for accepting
proposals through an addendum,
1.6 A proposal will be subject to being considered irregular and may be rejected if it shows
omissions, alterations of form, conditional alternate proposals, additions or alternates in lieu
of the items specified, if the unit prices are obviously unbalanced (either in excess of or
below reasonably expected values), or irregularities of any kind."
Q:Purchase/Bid Does/11-10144-DT
RFP 11 -10144 -DT. Self -Insured Health Care Auditing Services
2 PRE -PROPOSAL MEETING
2.1 For the purpose of familiarizing offerors with the requirements, answering questions, and
issuing addenda as needed for the clarification of the Request for Proposal (RFP)
documents, a 2re-2rol2osal meeting will be held at 10:00 a.m. MAY 17 2011 in Room 204
at Cijy Hall 1625 13 Street Lubbock Texas. All persons attending the conference will be
asked to identify themselves and the prospective offeror they represent.
2.2 It is the offeror's responsibility to attend the pre -proposal meeting though the meeting is not
mandatory. The City will not be responsible for providing information discussed at the pre -
proposal meeting to offerors who do not attend the pre -proposal meeting.
2.3 The City of Lubbock does not discriminate against person with disabilities. City of Lubbock
pre -proposal meetings are available to all persons regardless of disability. If you would like
information made available in a more accessible format or if you desire assistance, please
contact the City of Lubbock ADA Coordinator, 1625 13th Street, (806)775-2018 at least
forty-eight (48) hours in advance of the conference.
3 CLARIFICATION OF REQUIREMENTS
3.1 It is the intent and purpose of the City of Lubbock that this request permits competitive
proposals. It is the offeror's responsibility to advise the City of Lubbock Director of
Purchasing and Contract Management if any language, requirements, etc., or any
combinations thereof, inadvertently restricts or limits the requirements stated in this RFP to
a singJe source. Such notification must be submitted in writing and must be received by the
City of Lubbock Purchasing Office no later than five (5) business days prior to the proposal
closing date. A review of such notifications will be made.
3.2 ALL REQUESTS FOR ADDITIONAL INFORMATION OR CLARIFICATION
CONCERNING THIS REQUEST FOR PROPOSAL (RFP) MUST BE SUBMITTED
IN WRITING NO LATER THAN FIVE (5) BUSINESS DAYS PRIOR TO THE
PROPOSAL CLOSING DATE AND ADDRESSED TO:
D'Ana Tones, Buyer
City of Lubbock
1625 1311" Street
Lubbock, Texas79401
Fax: (806) 775-2164
Email: [name]@mylubbock.us
BidSync: www.bidsync.com
4 ADDENDA & MODIFICATIONS
4.1 Any changes, additions, or clarifications to the RFP are made by ADDENDA information
available over the Internet at www.bidsync.com. We strongly suggest that you check for
any addenda a minimum of forty-eight hours in advance of the response deadline.
BUSINESSES WITHOUT INTERNET ACCESS may use computers available at most
public libraries.
4.2 Any offeror in doubt as to the true meaning of any part of the RFP or other documents may
request an interpretation thereof from the Purchasing and Contract Management
Department. At the request of the offeror, or in the event the Purchasing and Contract
Q:Purchase/Bid Docs/1 WO 144 -DT
RFP 1140144 -DT, self -Insured Health Care Auditing services
Management Department deems the interpretation to be substantive, the interpretation will
be made by written addenda issued by the Purchasing and. Contract Management
Department. Such addenda issued by the Purchasing and Contract Management Department
will be available over the Internet at www.bidsync.com and will become part of the
proposal package having the same binding effect as provisions of the original RFP. No
verbal explanations or interpretations will be binding. In order to have a request for
interpretation considered, the request must be submitted in writing and must be received by
the City of Lubbock Purchasing and Contract Management Department no later than five
(5) days prior to the proposal closing date.
4.3 The City does not assume responsibility for the receipt of any addendum sent to offerors.
5 EXAMINATION OF DOCUMENTS AND REQUIREMENTS
5.1 Each offeror shall carefully examine all RFP documents and thoroughly familiarize itself
with all requirements prior to submitting a proposal to ensure that the proposal meets the
intent of this RFP.
5.2 Before submitting a proposal, each offeror shall be responsible for making all investigations
and examinations that are necessary to ascertain conditions and requirements affecting the
requirements of this RFP. Failure to make such investigations and examinations shall not
relieve the offeror from obligation to comply, in every detail, with all provisions and
requirements of the Request for Proposal.
G PROPOSAL COPIES
6.1 OFFEROR'S MUST SUBMIT THE ORIGINAL AND THREE COPIES OF THE
SEALED PROPOSAL TO THE PURCHASING AND CONTRACT MANAGEMENT
DEPARTMENT PRIOR TO RESPONSE DUE DATE/TIME. FAILURE TO SUBMIT;
THE ADDITIONAL COPIES MAY RESULT IN THE PROPOSAL BEING DECLARED
UNRESPONSIVE. The original must be clearly marked. "ORIGINAL" and the copies
must be clearly marked "COPY""
6.2 All proposals, responses, inquiries, or correspondence relating to or in reference to this
RFP, and all electronic media, reports, charts, and other documentation submitted by
offerors shall become the property of the City of Lubbock when received.
7 PROPOSAL PREPARATION COSTS
7.1 Issuance of this RFP does not commit the City of Lubbock, in any way, to pay any costs
incurred in the preparation and submission of a proposal.
7.2 The issuance of this RFP does not obligate the City of Lubbock to enter into contract for
any services or equipment.
7.3 All costs related to the preparation and submission of a proposal shall be paid by the
proposer.
8 TRADE SECRETS, CONFIDENTIAL INFORMATION AND THE TEXAS PUBLIC
INFORMATION ACT
8.1 If you consider any portion of your proposal to be privileged or confidential by statute or
judicial decision, including trade secrets and commercial or financial information, clearly
identify those portions.
Q:Purchase/Bid Docs/11-10144-DT 7
RFP 11-14144DT. Self -Insured Health Care Auditing Services
8.2 Proposals will be opened in a manner that avoids disclosure of the contents to competing
offerors and keeps the proposals secret during negotiations. All proposals are open for
public inspection after the contract is awarded, but trade secrets and confidential
information in the proposals are not open for inspection. Tex. Loc. Govt. Code 252.049(b)
8.3 The City of Lubbock will honor your notations of trade secrets and confidential information
and decline to release such information initially, but please note that the final determination
of whether a particular portion of your proposal is in fact a trade secret or commercial or
financial information that may be withheld from public inspection will be made by the
Texas Attorney General or a court of competent jurisdiction. In the event a public
information request is received for a portion of your proposal that you have marked as being
confidential information, you will be notified of such request and you will be required to
justify your legal position in writing to the Texas Attorney General pursuant to Section
552.305 of the Government Code. In the event that it is determined by opinion or order of
the Texas Attorney General or a court of competent jurisdiction that such information is in
fact not privileged and confidential under Section 552.110 of the Government Code and
Section 252.049 of the Local Government Code, then such information will be made
available to the requester.
8.4 Marking your entire proposal CONFIDENTIAUPROPRIETARY is not in conformance
with the Texas Open Records Act.
9 DISADVANTAGED BUSINESS ENTERPRISE (DBE) REQUIREMENTS
9.1 The City of Lubbock hereby notifies all offerors that in regard to any contract entered into
pursuant to this RFP, Disadvantaged Business Enterprises (DBE's) will be afforded equal
opportunities to submit proposals and will not be discriminated against on the grounds of
race, color, sex, disability, or national origin in consideration of an award.
9.2 A DBE is defined as a small business concern which is at least 51 % owned and controlled
by one or more socially and economically disadvantaged individuals, or in the case of any
publicly owned business, at least 51 % of the stock of which is owned by one ore more
socially and economically disadvantaged individuals. Socially and economically
disadvantaged include Women, Black Americans, Hispanic Americans, Native Americans,
Asian -Pacific Americans, and Asian -Indian Americans.
10 HISTORICALLY UNDERUTILIZED BUSINESS (HUB) REQUIREMENTS
10.1 The City of Lubbock hereby notifies all offerors that in regard to any contract entered into
pursuant to this RFP, Historically Underutilized Businesses (HUB's) will be afforded equal
opportunities to submit proposals and will not be discriminated against on the grounds of
race, color, sex, disability, or national origin in consideration of an award.
10.2 A HUB is defined as a small business concern which is at least 51% owned and controlled
by one or more socially and economically disadvantaged individuals, or in the case of any
publicly owned business, at least 51% of the stock of which is owned by one ore more
socially and economically disadvantaged individuals. Socially and economically
disadvantaged include Women, Black Americans, Hispanic Americans, Native Americans,
Asian -Pacific Americans, and Asian -Indian Americans.
Q:P=haseBid Docs/11-10144-DT 8
RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
11 CONFLICT OF INTEREST
11.1 The Offeror shall not offer or accept gifts or anything of value nor enter into any business
arrangement with any employee, official or agent of the City of Lubbock.
11.2 By signing their proposal, the offeror certifies and represents to the City the offeror has not
offered, conferred or agreed to confer any pecuniary benefit or other thing of value for the
receipt of special treatment, advantage, information, recipient's decision, opinion,
recommendation, vote or any other exercise of discretion concerning this RFP.
12 ANTI -LOBBYING PROVISION
12.1 DURING THE PERIOD BETWEEN PROPOSAL SUBMISSION DATE AND THE
CONTRACT AWARD, PROPOSERS, INCLUDING THEIR AGENTS AND
REPRESENTATIVES, SHALL NOT DIRECTLY DISCUSS OR PROMOTE THEIR
PROPOSAL WITH ANY MEMBER OF THE LUBBOCK CITY COUNCIL OR CITY
STAFF EXCEPT UPON THE REQUEST OF THE CITY OF LUBBOCK PURCHASING
DEPARTMENT IN THE COURSE OF CITY -SPONSORED INQUIRIES, BRIEFINGS,
INTERVIEWS, OR PRESENTATIONS.
12.2 This provision is not meant to preclude offerors from discussing other matters with City
Council members or City staff. This policy is intended to create a level playing field for all
potential offerors, assure that contract decisions are made in public, and to protect the
integrity of the RFP process. Its purpose is to stimulate competition, prevent favoritism and
secure the best work and materials at the lowest practicable price, for the best interests and
benefit of the taxpayers and property owners. Violation of this provision may result in
rejection of the offeror's proposal.
13 AUTHORIZATION TO BIND SUBMITTER OF PROPOSAL
Proposals must show vendor name and address of offeror. The original proposal must be manually
signed by an officer of the company having the authority to bind the submitter to its provisions.
Person signing proposal must show title or AUTHORITY TO BIND THEIR FIRM IN A
CONTRACT. Failure to manually sign proposal will disqualify it.
14 ABOUT THIS DOCUMENT
This document is a Request for Proposal. It differs from an Request for Proposal in that the City of
Lubbock is seeking a solution, as described in the following General Requirements section, not a
bid/quotation meeting firm specifications for the lowest price. As such, the lowest price
proposed will not guarantee an award recommendation. Sealed proposals will be evaluated
based upon criteria formulated around the most important features of a product or service, of which
quality, testing, references, availability or capability, may be overriding factors, and price may not
be determinative in the issuance of a contract or award. The proposal evaluation criteria should be
viewed as standards that measure how well an offeror's approach meets the desired requirements
and needs of the City of Lubbock. Those criteria that will be used and considered in evaluation for
award are set forth in this document. The City will thoroughly review all proposals received. The
City will also utilize its best judgment when determining whether to schedule a pre -proposal
conference (before proposals are accepted), or meetings with offerors (after receipt of all
proposals). A Purchase Order/Contract will be awarded to a qualified offeror submitting the best
proposal. The City reserves the right to select, and subsequently recommend for an award,
Q:Purchase/Bid Docs/I 1 -10144 -DT 9
RFP 11 -10144 -DT. Self-insured Health Cam Auditing Services
the proposed service which best meets its required needs, quality levels, and budget
constraints.
15 EVALUATION PROCESS
15.1 All proposals will be evaluated by an evaluation committee and may include senior
management representatives, a financial officer, and/or an independent consultant.
15.2 Respondents to this RFP may be required to submit additional information that the City
may deem necessary to further evaluate the offeror's qualifications.
15.3 The committee will evaluate and numerically score each proposal in accordance with the
evaluation criteria included in the Request for Proposal.
15.4 The committee will arrive at a short list of the top respondents and these short-listed
respondents may be scheduled for a structured oral presentation and interview. Such
presentations will be at no cost to the City of Lubbock. At the end of the oral presentation
and interview, the evaluation of the short-listed respondents will be completed. The oral
interview may be recorded and/or videotaped.
16 SELECTION
16.1 Selection shall be based on the responsible offeror whose proposal is determined to be the
most advantageous to the City of Lubbock considering the relative importance of evaluation
factors included in this RFP.
16.2 NO INDIVIDUAL OF ANY USING DEPARTMENT HAS THE AUTHORITY TO
LEGALLY AND/OR FINANCIALLY COMMIT THE CITY TO ANY CONTRACT,
AGREEMENT OR PURCHASE ORDER FOR GOODS OR SERVICES, UNLESS
SPECIFICALLY SANCTIONED BY THE REQUIREMENTS OF THIS REQUEST FOR
PROPOSAL.
17 EQUAL EMPLOYMENT OPPORTUNITY
Offeror agrees that it will not discriminate in hiring, promotion, treatment, or other terms and
conditions of employment based on race, sex, national origin, age, disability, or in any way
violative of Title VII of 1964 Civil Rights Act and amendments, except as permitted by said laws.
18 NONAPPROPRIATION
All funds for payment by the City under this contract are subject to the availability of an annual
appropriation for this purpose by the City. In the event of non -appropriation of funds by the City
Council of the City of Lubbock for the goods or services provided under the contract, the City will
terminate the contract, without termination charge or other liability, on the last day of the then -
current fiscal year or when the appropriation made for the then -current year for the goods or
services covered by this contract is spent, whichever event occurs first. If at any time funds are not
appropriated for the continuance of this contract, cancellation shall be accepted by the Seller on
thirty (30) days prior written notice, but failure to give such notice shall be of no effect and the City
shall not be obligated under this contract beyond the date of termination.
19 PROTEST
19.1 All protests regarding the RFP process must be submitted in writing to the City Director of
Purchasing and Contract Management within five (5) business days following the opening
of proposals. This includes all protests relating to advertising of notices, deadlines, proposal
QTurchase/Bid Docs/11-10144-DT 10
RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
opening, and all other related procedures under the Local Government Code, as well as any
protest relating to alleged improprieties with the RFP process.
This limitation does not include protests relating to staff recommendations as to award of
contract. Protests relating to staff recommendations may be directed to the City Manager.
All staff recommendations will be made available for public review prior to consideration
by the City Council as allowed by law.
19.2 FAILURE TO PROTEST WITHIN THE TIME ALLOTTED SHALL
CONSTITUTE A WAIVER OF ANY PROTEST.
20. THE CITY RIGHT TO AUDIT
At any time during the term of the contract, or thereafter, the City, or a duly authorized
audit representative of the City or the State of Texas, at its expense and at reasonable times,
reserves the right to audit Contractor's records and books relevant to all services provided to
the City under this Contract. In the event such an audit by the City reveals any errors or
overpayments by the City, Contractor shall refund the City the full amount of such
overpayments within thirty (30) days of such audit findings, or the City, at its option,
reserves the right to deduct such amounts owing the City from any payments due
Contractor.
The City of Lubbock is aware of the time and effort you expend in preparing and submitting proposals to
the City. Please let us know of any requirement causing you difficulty in responding to our Request for
Proposal. We want to facilitate your participation so that all responsible firms can compete for the City's
business. Awards should be made approximately two to six weeks after the opening date. Ifyou have any
questions, please contact the City of Lubbock Director of Purchasing and Contract Management at (806)
775-2572.
Q;Purehase/Bid Does/11-10144-DT 11
11. GENERAL REQUIREMENTS
1 INTENT
RFP 11 -14144 -DT, Self -Insured Health Care Auditing Services
The City of Lubbock (hereinafter called "City") is seeking proposals from interested firms and
individuals, (hereinafter called "Proposer") to provide Self -Insured Health Care Auditing Services.
2 PROJECT DESCRIPTION
Background
In January 2007, The City of Lubbock changed their third party administrator (TPA) for it's self-funded
health insurance program. For the 2009 plan year, there were approximately 2,515 subscribers plus
approximately 2,863 dependents in the program. For 2010, there were approximately 2,570
subscribers plus approximately 2,929 dependents in the program. Blue Cross Blue Shield of Texas
(BCBS) provided the Administrative Services Only (ASO) for medical and dental coverage for 2009,
2010, and 2011 plan years. BCBS provided one PPO plan with Blue Choice to the subscribers and
dependents. BCBS was not the Pharmacy Benefits manger (PMB) during any of the plan years. The
PBM for all years was Maxor Plus. HM Life provided the individual and aggregate stop loss insurance
for all five plan years.
The City provides health benefits to pre -Medicare and Medicare eligible retirees.
The plan is financed on a self-funded basis where weekly medical, dental, and pharmaceutical claims
for the City plan are paid. For the 2009 plan year, 40,706 medical service claims, 6,242 dental claims,
and 60,270 pharmacy claims costs totaling $18,039,468. For 2010 plan year, 48,186 medical service
claims, 6,597 dental claims, and 61,563 pharmacy claims paid totaling $21,504,090. For the current
2011 plan year, approximately 10,806 medical claims, 1,660 dental claims, and 15,961 pharmacy
claims have been paid as of March 31, 2011 for a total of $5,760,474. In addition, The City had
individual stop -loss insurance to mitigate risk when claims reach over $250,000 for plan year 2009,
and a $356,000 for plan years 2010 and 2011 per individual covered. Standard medical ASO fees, and
individual and aggregate stop loss insurance premiums, are invoiced by HM Life and paid on a
monthly basis.
3 PURPOSE OF THE PROJECT
It is the intent of the City to verify that the TPA and PBM have been administering the City of Lubbock
Health Benefit Plan in accordance with the terms of the contracts in place at the time of claim
adjudication.
All data files necessary for testing will be requested from BCBS and Maxor by the Proposer.
Additionally, eligibility verification for the claim population will be confirmed by the City. Provided
below is a list of areas that will be expected to be covered in the audit. Due to the period being audited
and the changes in contracts, please provide the recommended sample technique and size. The
Proposer may recommend additional testing areas as appropriate.
4 SCOPE OF WORK
QTurehase/Bid DDesll1-10144-DT 12
RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
Services requested in this RFP include, but are not limited to, reviews of the following:
Medical Claims Processing and Payments
Through analysis of paid medical claims data received from the TPA for the 2009, 2010, and 2011
plan years:
(a) Determine whether any claimants met the requirements to apply for stop loss insurance
during the audit period.
(b) Determine whether any claimant's annual/lifetime maximums were reached and whether
the appropriate action was taken.
(c) Identify potential duplicate payments, including claims for the same services with different
procedure codes.
(d) Perforin an analysis of procedure codes taking into consideration all elements that affect
pricing (provider type, point of service, diagnosis, secondary diagnosis, etc.) and identify
questionable variances. Report variances to the Human Resources staff and assist in
determining cause and recommending possible steps for resolution.
(e) For all plan years, review performance standards included in the contract between BCBS
and The City and determine whether the stated benchmarks were met.
(f) For all plan years, review cumulative claims data and determine whether annual network
provider discount targets included in the contact between BOBS and the City were met.
(g) Proved sufficient evidence (such as copies of billing errors, coding errors, etc.) to
substantiate any errors.
(h) For the plan year 2011, review claims data and determine that claims were paid in
accordance with the City's desire to remain grandfathered.
For a sample of medical claims, perform a detailed line item review of provider billings to include the
following tests:
• Verify the provider status on the date of service as being In Network or Out of Network.
• Re -adjudicate the claims sampled as appropriate. Tests should include a review of pricing,
verifying that procedure codes on the date of service were for benefits covered under the
plan, look for potential upcoding or unbundling, inappropriate CCI edits and OCE edits,
mutually exclusive codes, sex inappropriate procedure codes, excessive billed quantities,
etc. Review contracts as necessary.
• Verify that sufficient documentation was provided to support the claim payment and an
adequate review was performed, taking into consideration the claim dollar amount.
• Determine whether the proper application of deductibles and/or timely coordination of
benefits and subrogation took place (integration with Medicare, third party liability,
duplicate coverage, and worker's compensation), including retirees and active employees
over the age of 65. For identified claims, where it is applicable, determine if funds were
received and applied to the City or were deducted from the bill accurately.
• For plan all plan years, determine whether claims were submitted by the provider and paid
by BCBS in accordance with performance contract standards for health benefits terms,
including timeliness, financial accuracy, and procedural accuracy.
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RR 11 -16144 -DT, Self-insured Health Care Auditing Services
• Provide sufficient evidence (such as copies of billing errors, coding errors, etc.) to
substantiate any errors.
Dental Claims Processing and Payments
Through analysis of paid dental claims data received from the TPA for the 2009, 2010, and 2011 plan
years:
• Identify potential duplicate payments.
• Determine whether any claimant's annual/lifetime maximums were reached and whether
the appropriate action was taken.
• Identify potential duplicate payments, including claims for the same services with different
procedure codes.
• Provide sufficient evidence to substantiate any errors.
For a sample of dental claims, perform these additional tests:
• Determine whether dental claims were paid according to the agreed upon discount
arrangements and reimbursement rates and assigned to the appropriate tier for payment.
• Re -adjudicate the claims sampled as appropriate. Tests should include a review of pricing,
verifying that procedure codes on the date of service were for benefits covered under the
plan, look for potential excessive billed quantities, etc. Review contracts as necessary.
• Provide sufficient evidence (such as copies of billing errors, coding errors, etc.) to
substantiate any errors.
Pharmaceutical Claims Processiniz and Payments
Through analysis of paid pharmaceutical claims data received from the TPA for the 2009, 2010, and
2011 plan years:
• Identify potential duplicate payments.
• For all plan years, ensure rebates were credited according to contract terms.
• Provide sufficient evidence to substantiate any errors.
For a sample of pharmaceutical claims, perform these additional tests:
• Determine whether pharmaceutical claims were paid according to the agreed upon discount
arrangements and reimbursement rates and assigned to the appropriate tier for payment.
• Determine calculation accuracy including ingredient costs and dispensing fees.
• Provide sufficient evidence (such as copies of billing errors, coding errors, etc.) to
substantiate any errors.
When fieldwork is complete, review the results with BOBS and Maxor then meet with the City to
present the results of the audit and assist with securing any corrective action necessary.
Communication and Collaboration with City Human Resources Staff
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RFP 11 -10144 -dT, Self -Insured Health Care Auditing Services
City Human Resources staff may accompany the winning Proposer to the audit site. The Human
Resources staff will expect progress reports throughout the engagement and, at the discretion of
Human Resources, some of the progress report information will be requested in writing. These reports
will include details of issues to date. Also, it is expected that the Human Resources staff may consult
with the Proposer's staff as the need arises and after the audit has been performed. The selected
Proposer will be requested to provide a copy of all electronic data obtained during the course of the
audit in a delimited text file (including the table definition that describes the data elements), as legally
permitted per BCBS and Maxor contracts.
Deliverables
A final report will be presented to the City which should include, although not be limited to, the
following:
• A projection of the range of the total dollar population of claims paid for the audit period
determined statistically from the sampling results and the sampling criteria for each
calendar year audited.
• A projection of total errors in the population based on the sampling results (by plan year),
including the methodology used for the projection.
• A schedule of known errors with sufficient detail to present to BCBS and/or Maxor for
refund or settlement, including the cause(s) of the error, if determinable. The dollar amount
of the error should be presented in a format that will indicate a detailed description of the
claim, the original amount paid, amount per audit the difference between the original
amount paid and amount per audit, and explanation of the error.
• Specific recommendations on processes and procedures to prevent and detect future errors.
5 PROJECT METHODOLOGY
The proposal should include the recommended sample size based on the following approximate
number and value ad claims paid:
• 40,706 medical service claims, 6,242 dental service claims, and 60,270 pharmacy claims
paid for the 2009 plan year totaling $18 million
• 48,186 medical service claims, 6,597 dental service claims, and 61,563 pharmacy claims
paid for the 2010 plan year totaling $21.5 million
• 10,806 medical service claims, 1,660 dental service claims, and 15,961 pharmacy claims
paid through March 31, 2011 for the plan year 2011 totaling $5.7 million.
This should include how the sample will be selected to ensure sufficient coverage of high risk
claims as well as the number of strata used and the dollar range of each stratum in the sampling
methodology, if applicable. In addition, a description of the methodology that will be used to
extrapolate the sample audit results across the entire population shall be provided. The following
statistical parameters should be used for each sample from each plan year:
Confidence Level: 95%
Reliability (Precision): +/-2%
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RFP 11 -10144 -DT, Self-insured Health Care Auditing Services
Expected Error Rate: Less than 5%
Sample reports including the deliverable stated in Section 1. C., should be provided with the
proposal. Alternatives to the deliverables stated may also be presented for consideration.
Firms should list any prior work within the past five years where the firm either engaged in
business with BOBS or Maxor or any subsidiaries or organizations related to these two companies.
The firm should detail the services performed and the fee received.
6 EVALUATION CRITERIA
A Proposer may propose on all activities that it considers itself qualified to review. Proposer(s) will be
selected based upon the criteria set forth in the RFP. Qualifications will be judged in the area of
expertise and cited by the response of this RFP.
Any subcontractor must be identified in the initial proposal, including the name of the firm and all
other information as required of the principal firm in this RFP. The City reserves the right to reject any
proposed subcontractors. Once a contract is entered into with the successful Proposer, no additional
subcontracting will be allowed without the express prior written consent of the City.
b) Offerors are invited to submit demonstrated competence and qualifications of their firm for
providing these services.
c) The information contained within this document is intended to provide interested firms with the
requirements and criteria that will be used to make the selection.
The following criteria will be used to evaluate and rank submittals:
a) Substantial successful experience in competing similar projects that includes representations
regarding the firm's qualifications and demonstrated skill appropriate to this project and the
technical capabilities and professional competence of the Proposer and assigned personnel.
(30%)
b) Record of performance on similar projects based on previous work with the City and/or other
client references. (25%)
C) Cost. (25%)
d) Substantial capability to meet schedules and deadlines as well as the capability to complete
projects without having major cost escalations, change orders or overruns. (20%)
8 PROPOSAL FORMAT
a) Proposals should provide a straightforward, concise description of the Offeror's capabilities to
satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content,
and conveyance of the information requested by the City.
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b) The proposal should be bound in a single volume where practical. All documentation
submitted with the proposal should be bound in that single volume, notebooks preferred.
C) If the proposal includes any comment over and above the specific information requested in the
RFP, it is to be included as a separate appendix to the proposal.
d) The proposal must be organized into the following response item sections and submitted in an
indexed binder.
i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror's
understanding of the services to be provided. Include any additional information believed
necessary that is not requested elsewhere in the RFP.
ii) A description of the methodology to be used to complete the project to include, but not be
limited to, how recommendations will be formulated and commitment of adequate
appropriate resources to the project.
iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief
description of similar projects completed (with the dates of completion) or in progress and a
list of references by name, address, and telephone number for each project listed. This list
of projects in progress shall include the phase of work that each project is currently in (i.e.
design, bid, construction), and the estimated completion date.
iv) A brochure of past work, with emphasis on comparable projects.
v) List of principal(s) of the Proposer and amount of time that principal(s) will be involved in
the project.
vi) List of other professionals to be used, if applicable, with a record of experience in projects
of this nature. Identification of principal(s) and percentage of time the principal(s) will be
involved in the project.
vii) The organizational structure of the employees who will be assigned to this project along
with resumes of those individuals. If a joint venture is expected, then provide the
organizational structure of the sub -contractor and resumes of those persons who will be
involved in the project.
viii) The Proposer must assure the City that he/she will to the best of his/her knowledge,
information and belief, be cognizant of, comply with, and enforce, where applicable and to
the extent required, all applicable federal or state statutes and local ordinances including,
but not limited to the Davis -Bacon Federal minimum wage requirements.
ix) Describe the Offeror's methodology for handling errors and omissions.
x) Disclosure of any obligations posing a potential conflict of interest, including service on
City boards and/or commissions and any current contracts with the City of Lubbock. This
would apply to the Proposer as well as consultants subcontracted by the Proposer.
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RFP 11 -10144 -DT. Self -Insured Health Cam Auditing Services
xi) Any material which the proponent wishes to submit and which is not specifically requested
in the above categories.
xii) Offerors are strongly encouraged to explore and implement methods for the utilization of
local resources, and to outline how they would address outreach issues in their proposal. It
is also the desire of the City that the City of Lubbock program serve, as much as
practicable, to stimulate growth in all sectors of the local business community. Describe
how your firm would facilitate this process, and provide any relevant information about
similar efforts on previous projects.
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RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
Self -Insured Health Care Auditing Services
CITY OF LUBBOCK, TEXAS
RFP 11 -10144 -DT
II. INSURANCE
SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed
Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named
underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish
and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO
DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL
HAVE BEEN DELIVERED TO THE CITY.
INSURANCE COVERAGE REQUIRED
SECTION B. The City reserves the right to review the insurance requirements of this section during the
effective period of the contract and to require adjustment of insurance coverages and their limits when
deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the
claims history of the industry as well as the Contractor.
SECTION C. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are
approved by the City, the Contractor shall obtain and maintain in full force and effect for the duration of
this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by
companies approved by the State of Texas and acceptable to the City, in the following type(s) and
amount(s):
TYPE AMOUNT
1. Workers' Compensation and Employers Liability Insurance:
Contractor shall elect to obtain workers' compensation coverage pursuant to Section 406.002 of the Texas
Labor Code. Further, Contractor shall maintain said coverage throughout the term of this Lease and shall
comply with all provision of Title 5 of the Texas Labor Code to ensure that the Contractor maintains said
coverage. Any termination of workers' compensation insurance coverage by Contractor or any
cancellation or non -renewal of workers' compensation insurance coverage for the Contractor shall be a
material breach of this contract. The policy must be endorsed to include a waiver of subrogation in favor
of the City of Lubbock.
Employer's Liability with limits of at least $500,000 each accident, $500,000 by disease policy limit, and
$500,000 by disease each employee shall also be obtained and maintained throughout the term of this
Lease.
2. Commercial General (public) Liability insurance including coverage for the following:
a. Products/completed operations
b. Personal injury
c. Advertising injury
d. Contractual liability
Combined single limit for
bodily injury and property
damage of $500,000 per
occurrence or its equivalent.
The City of Lubbock shall be named a primary additional insured with a waiver of subrogation in
favor of the City on all coverage's. All copies of the Certificates of Insurance shall reference the RFP or
proposal number for which the insurance is being supplied.
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RFP 11 -10144 -DT, Self -Insured Health Care Auditing Services
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies and all
endorsements thereto and may make any reasonable request for deletion, revision, or modification of
particular policy terms, conditions, limitations, or exclusions (except where policy provisions are
established by law or regulation binding upon either of the parties hereto or the underwriter of any of such
policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish
such changes in policy coverages, and shall pay the cost thereof.
REQUIRED PROVISIONS
The Contractor agrees that with respect to the above required insurance, all insurance contracts and
certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the
following required provisions:
a. Name the City of Lubbock and its officers, employees, and elected representatives as additional
insureds, (as the interest of each insured may appear) as to all applicable coverage;
b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change;
c. Provide for notice to the City at the address shown below by registered mail;
d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees,
and elected representatives for injuries, including death, property damage, or any other loss to the
extent same may be covered by the proceeds of insurance;
e. Provide that all provisions of this contract concerning liability, duty, and standard of care together
with the indemnification provision, shall be underwritten by contractual liability coverage
sufficient to include such obligations within applicable policies.
f. All copies of the Certificates of Insurance shall reference the project name or proposal number for
which the insurance is being supplied.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices not
less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE
OF INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 13th Street, Room 204
Lubbock, Texas 79401
SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the
Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as
set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the
insurance company exonerate the Contractor from liability.
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RFP 11 -10144 -DT, $elf -Insured Health Cane Auditing Services
SUSPENSION AND DEBARMENT CERTIFICATION
Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non -Federal entities from
contracting with or making sub -awards under covered transactions to parties that are suspended or
debarred or whose principals are suspended or debarred. Covered transactions include procurement
contracts for goods or services equal to or in excess of 525,000 and all non -procurement transactions (e.g.,
sub -awards to sub -recipients).
Contractors receiving individual awards of $25,000 or more and all sub -recipients must certify that their
organization and its principals are not suspended or debarred by a Federal agency.
Before an award of $25,000 or more can be made to your firm, you must certify that your organization and
its principals are not suspended or debarred by a Federal agency.
1, the undersigned agent for the firm named below, certify that neither this firm nor its principals are
suspended or debarred by a Federal agency.
COMPANY NAME:
Signature of Company Official:
Date Signed:
Printed name of company official signing above:
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RFP 11 -10144 -DT. Self-lusured Health Care Auditing Services
CITY OF LUBBOCK, TEXAS
Self -Insured Health Care Auditing Services
RFP 11 -10144 -DT
INSURANCE REQUIREMENT AFFIDAVIT
To Be Completed by Offeror and Agent
And Attached to Submittal
1, the undersigned Offeror, certify that the insurance requirements contained in this proposal document have been reviewed by
me with the below identified Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock, I will be able to,
within ten (10) business days after being notified of such award by the City of Lubbock, furnish a valid insurance certificate to
the City meeting all of the requirements defined in this proposal. If this time requirement is not met, the City has the right to
reject the Offeror's proposal and award the contract to another Proposer.
Offeror (Signature) Offeror (Print)
Company Name (Print or Type)
Company Address
Name of AgentBroker (Print or Type)
Address of Agent/Broker City. State, Zip:
Phone Number Fax Number
Email Address
The City of Lubbock shall be named a primary additional insured with a waiver of subrogation in favor of the City on
all coverage's. All copies of the Certificates of Insurance shall reference the RFP or proposal number for which the insurance is
being supplied.
If you have any questions concerning these requirements, please contact the Purchasing and Contract Management Department
for the City of Lubbock at (806) 775-2572.
The Proposer must complete, sign and return as part of their submittal response.
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RFP 11-10144DT. Self -Insured Health Care Auditing Services
City of Lubbock
Consideration of Location of Offeror's Principal Place of Business
Affidavit of Eligibility
Pursuant to Subchapter Z, Chapter 271, Texas Local Government Code, In purchasing under this title any real property, personal property that
is not affixed to real property, or services, if a municipality receives one or more competitive sealed proposal from an offeror whose principal
place of business is in the municipality and whose proposal is within five percent of the lowest proposal price received by the municipality
from a offerors who is not a resident of the municipality, the municipality may enter into a contract for an expenditure of less than $100,000
with:
(1) the lowest offerors; or
(2) the offeror whose principal place of business is in the municipality if the governing body of the municipality determines, in writing,
that the local offeror offers the municipality the best combination of contract price and additional economic development
opportunities for the municipality created by the contract award, including the employment of residents of the municipality and
increased tax revenues to the municipality.
This section does not apply to the purchase of telecommunications services or information services, as those terms are defined by 47
U.S.C. Section 153.
In order to receive consideration, offeror must submit this affidavit to:
Marta Alvarez, Director of Purchasing
And Contract Management
City of Lubbock
1625 13's Street, Room 204
Lubbock, TX 79401
Complete all areas below. Incomplete affidavits may be rejected.
Local Business Name:
Local Address (must be within the City limits):
Address of the company's principal place of business within the United States:
I . How many residents of the City of Lubbock are employed at the above business location?
2. Year your business was established in the City of Lubbock:
3. For transactions that require sales tax, provide the following Reseller information:
Reseller Permit Number:
Company Name and Address (as it appears on permit):
4. Does your business have more than one office in the State of Texas? Yes No
If Yes, identify the office location considered as the point -of sale credit for sales tax purposes:
5. Was the local business required to pay business and/or real property tax for the most recent tax year?
Yes No
If Yes, did the local business pay any of this tax to the City of Lubbock? Yes No
Under penalty of perjury, the undersigned states that the foregoing statements are true and correct. It is further acknowledged that any person, firm, corporation
or entity intentionally submitting false information to the City in an attempt to qualify for eligibility shall be prohibited from bidding on City of Lubbock
products and services for a period of one (l) year.
Authorized Signature:
Printed Name and Title:
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Date: